Rapid Shallow Breathing Index (RSBI)
Predicts successful extubation, to be used only as a single component of the clinical picture.
Tips for COVID-19: Use to determine floor vs. ICU. Predicts successful extubation.
Use in intubated patients breathing spontaneously who meet other clinical criteria for weaning from mechanical ventilation. The RSBI should not be the sole determinant of extubation.
Management
Patients with RSBI <105 (“positive”):
- If the patient otherwise meets criteria for liberation from the ventilator, a positive RSBI means they are likely to have successful extubation.
- Clinicians can use the positive RSBI as an additional supporting data point for the decision to extubate.
Patients with RSBI >105 (“negative”):
- These patients are more likely to fail extubation.
- However, there are multiple confounding factors that make a patient more likely to have a negative RSBI, including female gender, smaller endotracheal tube size, and active suctioning during spontaneous breathing.
- If a patient has a negative RSBI, but in all other respects is ready for extubation, consider potential confounding factors at play resulting in an inflated RSBI value (i.e., a negative RSBI should not necessarily deter clinicians from deciding to extubate).
Critical Actions
- The RSBI is only applicable to patients that are clinically ready for weaning from the ventilator.
- It is not meant to answer the question of whether a patient is ready for extubation. Rather, it helps to predict the outcome after extubation.